Cancer is now a disease with a number of highly effective treatment options that are leading to a greater number of cancer survivors who are living long and productive lives. Globally, there are 10 million people diagnosed with cancer, and 10% of newly diagnosed men and women are under the age of 40 years. While aggressive radiation and chemotherapies are able to save and prolong their lives, disruption of reproductive function-including fertility and endocrine function-can be an unintended consequence that is particularly relevant for these young cancer patients. We have also come to recognize that many young women have non-malignant conditions or must undergo treatment with drugs or procedures that can damage their reproductive function. The proposed Northwestern University Center for Reproductive Health After Disease will therefore extend the overall scope of work to ensure that these women are provided options for protecting their reproductive health and that providers are aware of the threat posed by specific diseases and treatments on reproductive function. Moreover, our Center will not be limited to the preservation of fertility but will also address the long-term endocrine health of women who lose gonadal function. There are 20,000 women between the ages of 41 and 51 who are diagnosed with cancer each year, and while these women lie outside the age limit for experimental fertility interventions, they are in need of alternatives that will preserve ovarian endocrine support of various tissues, such as bone. The overall hypothesis of the Center is that effective options can be provided to young women with malignant or non-malignant disease who must undergo life-preserving cancer treatments and other medical interventions that will affect their reproductive health. By assembling a diverse, cross-disciplinary team of investigators, the Center will pursue both basic scientific research and clinical research goals, as well as create and implement educational and community outreach initiatives to share the Center's findings with providers, patients, their families, and the public Center researchers will investigate new techniques for producing healthy, mature oocytes from the pool of immature oocytes in ovarian tissue banked by young cancer patients. Another project will examine the cellular mechanisms that might be targeted to protect eggs from the damaging effects of radiation and chemotherapy; this work will be particularly important for preserving endocrine health in older women. Clinical research will be conducted to determine to what extent fertility concerns affect the medical decision making process of patients. With an expanded scope, a team-based approach to problem solving, and the goal of preserving not only fertility, but all aspects of reproductive health, our Center has the potential to impact the lives of many young women who are at risk of disease-related or iatrogenic infertility and endocrine dysfunction.